Republicans struggle to push health care bill over House finish line

Posted: 7:43 am Thursday, March 23rd, 2017

By Jamie Dupree

In a last minute bid to thread the needle between more conservative and more moderate Republicans, President Donald Trump and GOP leaders in the House are still hoping to bring a health care overhaul bill to a vote today, as they try to find a magic legislative formula that will produce a final agreement acceptable to a bare majority of Republican members.

Here’s where things stand.

1. Republicans still seem short on votes. Despite a full day of arm twisting and closed door meetings that stretched late into Wednesday night, the President seemed no closer to a majority in the House – in fact, the numbers seemed to go the wrong way yesterday, as several more moderate Republicans like Rep. Charlie Dent (R-PA) and Rep. Frank LoBiondo (R-NJ) announced they could not support the bill. “We gave our word that we would repeal and replace it,” said Rep. Ted Yoho (R-FL) of Obamacare. “This bill does not go far enough.” Yoho – a Freedom Caucus member – though said he was open to a last minute deal, but that remained elusive as the sun came up on Thursday. President Trump is set to meet with Freedom Caucus members just before lunch at the White House.

2. For some the negotiations just don’t matter. As we have seen on major legislation in recent years, there are a small group of Republicans who just aren’t going to get to a “Yes” vote under the current direction of negotiations. “We promised to repeal Obamacare and improve health care for Americans. This bill does neither,” said Rep. Justin Amash (R-MI), who is a certain “No” vote. Even as members of the House Freedom Caucus met into the night on Wednesday, it was obvious that some in that group, like Amash, would not get on board with the final product – and on their own, they have more than enough votes to sink this GOP bill if they withhold their support. This was a tweet from the group’s spokeswoman.

3. There is no groundswell of support back home. One peculiar situation about the GOP drive on health care is that they are not only taking flak from Democrats, but also from conservative groups who don’t like the direction of the bill – and that combination is bringing a distinct message from back home, as well as groups that watch GOP lawmakers like a hawk. “Unfortunately, even with recently submitted changes, the American Health Care Act has too many ObamaCare-like flaws,” the conservative group Freedom Works said in a statement. Other groups like the Heritage Foundation have been openly working to stop the bill as well – and lawmakers say the folks back home have made quite clear their dislike for the bill.

Rep Walter Jones R-NC on calls/emails from his district about GOP health care bill: 4 were in favor, 800 against

4. What late changes are being considered to the GOP bill? There was a lot of talk on Wednesday night of major alterations to the bill, some of which might not even survive tight Senate rules dealing with budget reconciliation. The work mainly centered on re-writing the definition of “Essential Health Benefits” in the Obama health law, to allow insurance companies to offer more limited – and therefore less expensive for consumers. Here is the EHB list in current law – these can be modified administratively by the Trump Administration and the Secretary of Health and Human Services; but a number of Republican lawmakers want them changed in law. That most likely will take 60 votes in the Senate.

5. Wait – the EHB change takes 60 votes in the Senate? The logical question to ask is – if you can’t change the Essential Health Benefits in a budget reconciliation bill, because it will get knocked out in the Senate, why put that in this House bill? Well, it may be the only way to get the bill out of the House with enough votes, and send it over to the Senate. Republicans were already engaged in public lobbying of the Senate Parliamentarian, who has the job of ruling on specific provisions of reconciliation bills, as they tried to argue in public that she might change her mind on the matter. Behind the scenes, it wasn’t really apparent that anything had changed along these lines, but the GOP hope was that if EHB changes were included in the bill, the provision could get through the House and just be knocked out in the Senate, without destroying the underlying measure.

6. Will the vote be Thursday or later? Republicans were ready to give themselves several days of wiggle room on the health care matter, as the House was expected to approve a measure that allows the GOP to quickly bring a final health care deal to the floor for a vote, any time over the next four days – through Monday. So, there could be a showdown vote on health care today, tomorrow, over the weekend, or early next week. Basically, if Republicans and the White House think they’ve got the votes, then they will rush to the House floor to push that through. “We have not cut the deal, yet,” Rep. Pete Sessions (R-TX) acknowledged late on Wednesday night in the House Rules Committee.

7. GOP ready to repeat the Nancy Pelosi 2010 quote. Republicans love to talk up the out-of-context quote from then House Speaker Nancy Pelosi in 2010, when she said the Congress would just have to pass a health care bill in order to see what was in it. If you really research the quote, you see she wasn’t saying that, but that hasn’t stopped the GOP from throwing it in her face for the past seven years. Now, Democrats are delighting in watching the GOP maybe doing the same thing. With major changes being looked at last night, it was not clear as the day began what exactly the Republicans would be voting on – and it was possible that no cost estimate, or insurance coverage estimate details would be ready for when lawmakers did vote in the House.

With no CBO score, the full effect of eliminating essential health benefits won't be known to House lawmakers before they vote #votingblind